The purpose of this study was to assess the current level of involvement of nurse practitioners (NPs) in activities related to preventing and managing fractures in long-term care (LTC). This study used a sequential explanatory mixed methods design that included two phases—a cross-sectional survey followed by qualitative interviews. A final sample of 12 NPs completed the online survey for a response rate of 67%. Eleven of the 12 NPs who completed the survey agreed to participate in a follow-up interview. NPs reported that they were quite engaged in managing fractures in LTC; specifically, they were most active in caring for residents post-fracture. NPs described their role as being holistic in nature in their assessment and treatments related to managing fractures. The findings from this mixed method study add to the growing body of knowledge related to how NPs manage fractures in LTC.
BakerjanD. (2008). Care of nursing home residents by advanced practice nurses. Research in Gerontological Nursing, 1, 177-185.
2.
BessetteL.Ste-MarieG.JeanS.DavisonK.BeaulieuM.BaranciM.BrownJ. P. (2008). The care gap in diagnosis and treatment for women with a fragility fracture. Osteoporosis International, 19, 79-86.
3.
ChenJ. S.CameronI. D.SimpsonJ. M.SeibelM. J.MarchL. M.CummingR. G.SambrookP. N. (2011). Low-trauma fractures indicate increased risk of hip fracture in frail older people. Journal of Bone and Mineral Research, 26, 428-433.
College of Nurses of Ontario. (n.d.). Nurse practitioners: Standards and guidelines. Available from http://www.cno.org/np
6.
CrabtreeB.MillerW. (1999). Doing qualitative research (2nd ed.). London, England: Sage.
7.
CreswellJ.ClarkV.GutmannM.HansonW. (2003). Advanced mixed methods research designs. In TashakkoriA.TeddlieC. (Eds.), Handbook of mixed methods in social and behavioral research (pp. 209-240). London, England: Sage.
8.
CummingsG.FraserK.TarlierD. (2003). Implementing advanced nurse practitioner roles in acute care: An evaluation of organizational change. Journal of Nursing Administration, 33, 139-145.
9.
deGuzmanA.CiliskaD.DiCensoA. (2010). Nurse practitioner role implementation in Ontario public health units. Canadian Journal of Public Health, 101, 309-313.
10.
DemontieroO.HerrmannM.DuqueG. (2011). Supplementation with vitamin D and calcium in long-term care residents. Journal of the American Medical Directors Association, 12, 190-194.
DilmanD. A. (1978). Mail and telephone surveys: The total design method. New York, NY: Wiley.
13.
DonaldF.MohideE. A.DiCensoA.BrazilK.StephensonM.Akhtar-DaneshN. (2009). Nurse practitioner and physician collaboration in long-term care homes: Survey results. Canadian Journal on Aging, 28, 77-87.
14.
EdwardsB. J.SongJ.DunlopD. D.FinkH. A.CauleyJ. A. (2010). Functional decline after incident wrist fractures—Study of osteoporotic fractures: Prospective cohort study. British Medical Journal, 8, c3324.
15.
GoldD. T. (1996). The clinical impact of vertebral fractures: Quality of life in women with osteoporosis. Bone, 18, 185S-189S.
16.
GreenspanS. L.PereraS.NaceD.ZukowskiK. S.FerchakM. A.LeeC. J.ResnickN. M. (2012). FRAX or fiction: Determining optimal screening strategies for treatment of osteoporosis in residents in long-term care facilities. Journal of the American Geriatrics Society, 60, 684-690.
17.
HopkinsR. B.TarrideJ. E.LeslieW. D.MetgeC.LixL. M.MorinS.. . . ThabaneL. (2013). Estimating the excess costs for patients with incident fractures, prevalent fractures, and nonfracture osteoporosis. Osteoporosis International, 24, 581-593.
18.
KaasalainenS.DiCensoA.DonaldF.StaplesE. (2007). Optimizing the role of the nurse practitioner to improve pain management in long-term care. Canadian Journal of Nursing Research, 39, 14-31.
19.
KanisJ. A.BurletN.CooperC.DelmasP. D.ReginsterJ. Y.BorgstromF.RizzoliR. (2008). European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporosis International, 19, 399-428.
20.
KanisJ. A.JohnellO.De LaetC.JohanssonH.OdenA.DelmasP.TenenhouseA. (2004). A meta-analysis of previous fracture and subsequent fracture risk. Bone, 35, 375-382.
21.
KennedyC.IoannidisG.GiangregorioL.AdachiJ.ThabaneL.MorinS. N.PapaioannouA. (2012). An interdisciplinary knowledge translation intervention in long-term care: Study protocol for the vitamin D and osteoporosis study (ViDOS) pilot cluster randomized controlled trial. Implementation Science, 7, 48.
22.
LauA.AliS.SawkaS.ThabaneL.PapaioannouA.GafniA.AdachiJ. (2008). Improvement in health-related quality of life in osteoporosis patients treated with teriparatide. BMC Musculoskeletal Disorders, 9, 151.
23.
MaggioD.UbaldiE.SimonelliG.CenciS.PedoneC.CherubiniA. (2001). Hip fracture in nursing homes: An Italian study on prevalence, latency, risk factors, and impact on mobility. Calcified Tissue International, 68, 337-341.
24.
Martinez-ReigM.AhmadL.DuqueG. (2012). The orthogeriatrics model of care: Systematic review of predictors of institutionalization and mortality in post-hip fracture patients and evidence for interventions. Journal of the American Medical Directors Association, 13, 770-777.
25.
NortonR.CampbellA. J.ReidI. R.ButlerM.CurrieR.RobinsonE.GrayH. (1999). Residential status and risk of hip fracture. Age and Ageing, 28, 135-139.
PapaioannouA.KennedyC.CampbellG.GiangregorioL.MaJ.AdachiJ. (2008, September). Treating osteoporosis in the elderly: An environment scan of nursing home prescribing in Ontario, Canada. Paper presented at the 30th ASBMR Annual Meeting, Montreal, Quebec, Canada.
28.
PapaioannouA.MorinS.CheungA.AtkinsonS.BrownJ.FeldmanS.. . . LeslieW. D. (2010). Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: Summary. Canadian Medical Association Journal, 182, 1864-1873.
29.
PapaioannouA.WattsN. B.KendlerD. L.YuenC. K.AdachiJ. D.FerkoN. (2002). Diagnosis and management of vertebral fractures in elderly adults. American Journal of Medicine, 113, 220-228.
30.
PattonM. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage.
RonaldL. A.McGregorM. J.McGrailK. M.TateR. B.BroemlingA. (2008). Hospitalization rates of nursing home residents and community-dwelling seniors in British Columbia. Canadian Journal of Anesthesia, 27, 109-115.
33.
SandelowskiM. (2000). Whatever happened to qualitative description?Research in Nursing & Health, 23, 334-340.
34.
SawkaA. M.IsmailaN.CranneyA.ThabaneL.KastnerM.GafniA.. . . PapaioannouA. (2010). A scoping review of strategies for the prevention of hip fracture in elderly nursing home residents. PLoS ONE, 5, e9515.
35.
SawkaA. M.IsmailaN.RainaP.ThabaneLStrausSAdachiJ. D.. . . PapaioannouA. (2010). Hip fracture prevention strategies in long-term care: A survey of Canadian physicians’ opinions. Canadian Family Physician, 56, e392-e397.
36.
SchlaichC.MinneH. W.BrucknerT.WagnerG.GebestH. J.GrunzeM.Leidig-BrucknerG. (1998). Reduced pulmonary function in patients with spinal osteoporotic fractures. Osteoporosis International, 8, 261-267.
37.
SeemanE. (2002). Pathogenesis of bone fragility in women and men. Lancet, 359, 1841-1850.
38.
Suarez-AlmazorM.HomikJ. E.MessinaD.DavisP. (1997). Attitudes and beliefs of family physicians and gynecologists in relation to the prevention and treatment of osteoporosis. Journal of Bone and Mineral Research, 12, 1100-1107.
39.
SugarmanJ. R.ConnellF. A.HansenA.HelgersonS. D.JessupM. C.LeeH. (2002). Hip fracture incidence in nursing home residents and community-dwelling older people, Washington State, 1993-1995. Journal of the American Geriatrics Society, 50, 1638-1643.
40.
WallM.LohfeldL.GiangregorioL.IoannidisG.KennedyC.MoserA.MorinS. (2013). Fracture risk assessment in long-term care: A survey of long-term care physicians. BMC Geriatrics, 13, 109. doi:10.1186/1471-2318-13-109
41.
ZimmermanS. I.GirmanC. J.BuieV. C.ChandlerJ.HawkesW.MartinA.MagazinerJ. (1999). The prevalence of osteoporosis in nursing home residents. Osteoporosis International, 9, 151-157.
